I don’t live in my feed aggregator any more and I don’t often read liblogs/biblioblogs.

I was lucky to have run into Jill Hurst-Wahl yesterday, though (we both live in Syracuse, but rarely cross paths)- and she mentioned this post to me. It’s good and I think the profession would benefit from thinking on it. Please read it. If you see why I think it is important, please share it and link to it.

Former Washburn University librarian Michelle Canipe contends in a recently filed lawsuit that Washburn Dean of Libraries Alan Bearman was abusive to her and other employees, even punching one in the face and head.

I take it back. It’s not unbelievable. I think most of us know someone who works somewhere made horrible by an abusive boss. I know a few someones who work in libraries with bosses nearly this bad.

Just wanted to take a minute to express my admiration for Michelle Canipe and her colleagues for DOING something.

The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as “the safety net of the safety net” for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care.

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Via PaleoFuture, this Knight Ridder video describes the iPad (okay “the tablet”…but Apple got there first) pretty damned well. Fascinating to me that an entity created by a newspaper company had this sort of prescience…and totally failed to act on it.

“Tablets will be a whole new class of computer, they’ll weigh under two pounds. They’ll be totally portable. They’ll have a clarity of screen display comparable to to ink on paper. They’ll be able to blend text, video, audio and graphics together and they’ll be part of our daily lives around the turn of the century. We may still use computers to create information, but we’ll use the tablet to interact with information.”

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Non-clinicians may not be familiar with “zebra” as a medical slang term.

Zebra is a medical slang term for a surprising diagnosis.[1] Although rare diseases are, in general, surprising when they are encountered, other diseases can be surprising in a particular person and time, and so “zebra” is the broader concept.

The term derives from the aphorism “When you hear hoofbeats behind you, don’t expect to see a zebra”, which was coined in a slightly modified form in the late 1940s by Dr. Theodore Woodward, a former professor at the University of Maryland School of Medicine in Baltimore.[2] Since horses are the most commonly encountered hoofed animal for most people and zebras are comparatively rarely encountered, logically one could confidently guess that the animal making the hoofbeats is probably a horse. By 1960, the aphorism was widely known in medical circles.[3]

There are times, though, when it makes sense to go looking for zebras.

Search engines like Google and database search (PubMed, EBSCO, whatever) rely on frequency and/or co-occurrence to rank search results, so common conditions are going to be easy to find and rank high in search results, while a rare disease/diagnosis will not.

FindZebra is a specialised search engine supporting medical professionals in diagnosing difficult patient cases. Rare diseases are especially difficult to diagnose and this online medical search engines comes in support of medical personnel looking for diagnostic hypotheses. With a simple and consistent interface across all devices, it can be easily used as an aid tool at the time and place where medical decisions are made. The retrieved information is collected from reputable sources across the internet storing public medical articles on rare and genetic diseases.

FindZebra indexes 31,000 articles on rare and genetic diseases from these sources:

Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University (Baltimore, MD) and National Center for Biotechnology Information, National Library of Medicine (Bethesda, MD). Available on www.ncbi.nlm.nih.gov/omim/

HqMeded-Ecg

Description: Dr. Stephen W. Smith is a faculty physician at Hennepin County Medical Center in Minneapolis, MN. He is known for his mastery of ECGs and his posts literally walk you through an ECG of an emergency department patient from start to finish.

CCPEM

Description: Mike Winters (U of Md), Peter DeBlieux (LSU), and Rob Rodriguez (UCSF). The website is a $60 investment in audio commentary by critical care experts, but the Twitter account is useful in providing and linking to critical care pearls around the net.

eMeducation

Description: Clay Smith is a clinical monster who completed IM-Peds as well as EM residencies and is now professor of all these disciplines at Vanderbilt in TN. His main push is evidence based medicine and you’ll enjoy the discussion of recent articles of interest.

UltrasoundPodcast

Description: Matt Dawson and Mike Mallin, both ultrasound directors at University of KY and University of UT respectively. Great podcast that any one from interns to attendings can listen to in order to up their game.

Emlitofnote

Description: Want to know the hot articles that everyone in EM is reading? Look no further than Ryan Radecki’s site. You’ll find critical appraisals of current literature that typically start a discussion among other EM bloggers.

Life in the Fastlane

Description: Authors at Life in the Fast Lane (Mike Cadogan, Kane Guthrie, Chris Nickson, and Michelle Johnston), one of the pre-eminent blogs on everything emergency medicine and some of the biggest proponents of FOAM (free open access medical education).

Academic Life in EM

Description: Michelle Lin leads a team of Physician writers in providing tips for EM. She is legendary for her Paucis Verbis cards — great quick reference cards that you can link to your dropbox and evernote account for free. Her blog is great for in depth lit reviews as well.

In addition to the twitter handles, podcasts, and blogs of these social media patrons, you can also find feeds by eminent journals and emergency medicine colleges as well (i.e. @JAMA_current, @NEJM, @AnnalsofEM, @EmergencyDocs (ACEP)). You may also want to visit http://www.foamem.com/ which is an RSS feed that collates many of these resources together.

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I’ve been doing a lot of Web development since I started a new job in June. This has been (pleasantly) challenging for a number of reasons. The environment is brand-new to me and, in comparison to other places I’ve worked, large and complex.

For instance, I’ve never developed in ColdFusion before and one of my Web applications needs to have the front end (a public-facing side on the public-facing server for users) on a ColdFusion8 server and the back-end of (used by members of my own department) lives behind the firewall, in our intranet, and runs ColdFusion9…so I’m learning two version of ColdFusion at the same time.

And I’ve worked with Sybase and MySQL databases, but Oracle is new to me. The Database Administrator I work with is a friendly, immensely helpful guy who I try to avoid bugging unless I’m really, really stuck. Developers far more experienced and skillful than me have all admonished me: “Be very, very nice to your DBA.”

So when I run into problems, I tend to head back to the manuals for the software I’m using (Oracle’s SQL Developer, PL/SQL Developer), but sometimes that doesn’t give me the sort of quick, painless solutions I crave.

Last week, I wanted to compare the data in a restored backup to the data in our production database and generate a script to copy the missing restored data to the production database. I asked my DBA and a far more experienced developer what tool I could use to accomplish this quickly and easily.

Neither had any suggestions- though both agreed that it would be wonderful if such a tool existed.

It turns out that such a tool DOES exist- and is awesome. A little Googling turned up Data Compare for Oracle from Red Gate Software- which is part of their Deployment Suite for Oracle.
I downloaded the free, fully functional trial and was so blown away by it that I emailed Red Gate to tell them so.

The interface is intuitive and well-designed- without spending a single second on any manual or help files, I made my comparisons and generated a deployment script within minutes of installing the application. Go check out the screen shots on Red Gate’s site to see how simple it is to use.

I was able to compare two databases on two different servers, limit the comparison to specific tables and criteria, drill down for details on the comparison, and generate a script to make the changes I needed. In minutes. Seriously.

Blown. Away.

To my delight, I was able to wrangle a license for my own use at work. This was an enormous relief, as the thought of losing it at the end of the 14-day trial brought tears to my eyes.

Download the trial and try it.

(Does anyone recall the last time I so nakedly endorsed a product? I don’t. That’s how much I like it.)

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Just realized that I have not yet mentioned here that I don’t work in a medical library any longer.

A few months ago, I took a job as the geek (technologist-generalist?) for the Department of Emergency Medicine at SUNY Upstate. I love the job. Love it. The people are great and the work is both challenging and interesting.

While I have really enjoyed shifting more to the mechanics of health information than the content, I’ve found certain librarianish habits and interests haven’t faded.

“There is a way of understanding how much modern medicine has to offer individual patients. It is a simple statistical concept called the “Number-Needed-to-Treat”, or for short the ‘NNT’. The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person. The concept is statistical, but intuitive, for we know that not everyone is helped by a medicine or intervention — some benefit, some are harmed, and some are unaffected. The NNT tells us how many of each.”

I guess I took that point reasonably well (as I understood it). In the context of this talk with the CIO, it meant that it was often not a wise use of resources to pursue perfection when we already had (or could easily achieve “serviceable.”

But whenever I thought of this talk with the CIO, the phrase “good enough” kept rubbing me the wrong way.

I’m not a perfectionist. Perfection is an ideal, not an acheivable goal. Striving for perfection, in my opinion, leads to unsociable behaviors, stress-induced health conditions, and really, really annoying people.like Phil Hartman’s The Anal-Retentive Chef I miss Phil Hartman.

On the other hand, I don’t think “good enough” is an acceptably high bar. When we deliver services to our customers/patrons/clients, should’t we be shooting for “excellence”? Excellence is do-able.

It seems to me that, most of the time, the amount of effort that would bridge the difference between “good enough” and “excellent” is small and that “excellence” pays dividends in extra-satisfied customers/patrons/clients that it is absolutely worth investing.

On the other side of that is that users/clients/customers/patrons are usually savvy enought to know “good enough” when they see it. It tells that that ther needs really aren’t the priority. Rather than paying dividends, it costs.

So. My new motto is this:

“Good enough” is the enemy of excellence. Strive for excellence and know when to stop reaching for the impossible goal of perfection.

How do you know when you’ve achieved excellence? Ask your users/clients/customers/patrons.

Okay, I admit I’m already reading this one- and LOVING it. Gleick (who also wrote a great biography of Richard Feynman), writes in a fascinating, engaging way about the history of information and of information technology. This book wonderfully illuminates how we got where we are and provides hints at where we might be going.

I would like a stack of 20 copies, please, so I can give one to each of my favorite 20 technology-resistant librarians.

This looks like one I’d love to read- and it is being released in May.

“This step-by-step guide provides encouragement, support, and direction for health librarians who may be new to research and evaluation or lacking in confidence or expertise. With a focus on practice-based research, evaluation, and small projects, it guides the reader through the research process, from starting to think about the research question, through to the completion of the research and dissemination of the results. It is designed to encourage quality research from library professionals and encourage them to add to the evidence base in this sector. This timely collection considers methods and approaches that are suitable in a health library context, making it a useful tool for health library professionals and students alike.”

This one was released in December, but I haven’t gotten to it yet- and I’ve been instructed quite sternly to read everything Sharon Strauss writes.

“Evidence Based Medicine provides a clear explanation of the central questions: how to ask answerable clinical questions; how to translate them into effective searches for the best evidence; how to critically appraise that evidence for its validity and importance; and how to integrate it with patients’ values and preferences.”

Rachel Walden taught me what a “librarian crush” is, and I have had a librarian crush on Jessamyn since I saw these signs.

Teaching novice computer users, including seniors and individuals with disabilities such as low vision or motor skills, how to do what they want and need to do online is a formidable challenge for library staff. Part inspirational, part practical Without a/the Net: Librarians Bridging the Digital Divide is a summary of techniques, approaches, and skills that will help librarians meet this challenge.

Jessamyn C. West’s experience as a librarian is deeply immersed in technology culture, yet living in rural America makes her uniquely qualified to write this book. Taking a big-picture approach to the subject, she demystifies and simplifies tech training for the busy librarian, providing an easy-to-use handbook full of techniques that can be used with all of a library’s many populations. As an added bonus, she also examines the players in the library technology arena to offer firsthand reports on what works, what doesn’t, and what’s next.

Libraries have existed for millennia, but today the library field is searching for solid footing in an increasingly fragmented (and increasingly digital) information environment. What is librarianship when it is unmoored from cataloging, books, buildings, and committees? In The Atlas of New Librarianship, R. David Lankes offers a guide to this new landscape for practitioners. He describes a new librarianship based not on books and artifacts but on knowledge and learning; and he suggests a new mission for librarians: to improve society through facilitating knowledge creation in their communities.

The vision for a new librarianship must go beyond finding library-related uses for information technology and the Internet; it must provide a durable foundation for the field. Lankes recasts librarianship and library practice using the fundamental concept that knowledge is created though conversation. New librarians approach their work as facilitators of conversation; they seek to enrich, capture, store, and disseminate the conversations of their communities.

To help librarians navigate this new terrain, Lankes offers a map, a visual representation of the field that can guide explorations of it; more than 140 Agreements, statements about librarianship that range from relevant theories to examples of practice; and Threads, arrangements of Agreements to explain key ideas, covering such topics as conceptual foundations and skills and values. Agreement Supplements at the end of the book offer expanded discussions. Although it touches on theory as well as practice, the Atlas is meant to be a tool: textbook, conversation guide, platform for social networking, and call to action.

“Are you using mind mapping tools such as MindManager, FreeMind or XMind? And reference management tools such as JabRef, Endnote, or Zotero? And do you sometimes even create bookmark in PDFs? Then you should have a look at SciPlore MindMapping.”

My need for PDF management tools is really pretty specific and infrequent. What about you academic folks? Is this something you could use?

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My Primary Care Physician is a good guy. His practice implemented an EMR a few years ago- each time I see him, I ask him how that’s going and he lets me see how it looks on the tablet PC he carries into the exam room.

My last visit was for an annual checkup a few weeks ago and we were talking about point-of-care tools and integration with his EMR. It turns out that their EMR has no useful functionality to help find or produce patient education handouts he can quickly sent to a printer

I told him it would not be difficult to make a tool that would enable him to find authoritative handouts quickly and easily from the paid resources his practice has available, and he expressed interest in that idea.

He hasn’t followed up, but I found the idea interesting, so I started thinking about what sort of tool could be built for this purpose that could be integrated into any EMR using only patient handouts that are available at no cost on the Web.

With that in mind, I came up with a Google Custom Search Engine for use by providers at our hospital, but I see no reason why it couldn’t be used by any institution or practice.

The idea behind this is that any search result is not only authoritative, but that it is within a click of a “print” button.

There are built-in refinements for large print, pediatrics, Spanish language, Seniors, and low literacy.